Practice Essentials

Benign tumors of the small bowel are rare clinical entities that often remain asymptomatic throughout life.^{[1, 2, 3, 4, 5]} Despite comprising 75% of the length and 90% of the surface area of the gastrointestinal (GI) tract, the small bowel harbors relatively few primary neoplasms and fewer than 2% of GI malignancies.^[6]

Benign small-bowel tumors may develop as a single lesion or as multiple lesions of several subtypes. Subtypes include the following:

Hyperplastic polyps
Hamartomas
Adenomas
Gut stromal tumors
Lipomas
Hemangiomas
Those associated with Peutz-Jeghers syndrome ^[7]

A multicenter study from Taiwan found hamartomas and adenomas to be the most common benign small-bowel tumors.^[8]

Benign small-bowel tumors are generally characterized by slow growth and delayed clinical presentation. They often remain inherently asymptomatic, only to be discovered incidentally at autopsy.

Strict medical management currently has no role in benign small-bowel tumors. Surgical excision remains the recommended therapy for these tumors. (See Treatment.)

Pathophysiology

Benign small-bowel tumors may be found throughout the duodenum, jejunum, and ileum (in order of increasing frequency). Tumors may be single, multiple, or widespread (ie, as part of a polyposis syndrome). The following three growth patterns have been identified:

Intraluminal
Infiltrative
Serosal

Intraluminal lesions are most often associated with the development of secondary bowel obstruction and intussusception, whereas serosal lesions are linked to small-bowel volvulus.

Several factors have been suggested to explain both the scarcity of small-bowel lesions and the infrequency of their malignant transformation, as follows^[9]:

First, rapid intestinal transit through the small bowel limits contact time to the small-bowel mucosa
Second, greater fluidity of small-bowel chyme may dilute luminal irritants
Third, alkaline pH may play a role, as may the low bacterial colony counts of the small bowel
Finally, higher levels of benzyl peroxidase (thought to detoxify potential carcinogens) have been detected in the small bowel

Together, with increased levels of immunoglobulin A and widespread gut lymphoid tissue, these factors may impede the growth and development of tumors and their malignant transformation.

Epidemiology

Benign small-bowel lesions have been documented in persons of all age groups, though the mean age of presentation reportedly is between the fifth and sixth decades of life. Several series have noted a slight predominance in males compared to females. No racial or ethnic predisposition has been discovered.

Clinical Presentation

Pourmand K, Itzkowitz SH. Small Bowel Neoplasms and Polyps. Curr Gastroenterol Rep. 2016 May. 18 (5):23. [Medline].
Ashley SW, Wells SA Jr. Tumors of the small intestine. Semin Oncol. 1988 Apr. 15 (2):116-28. [Medline].
Blanchard DK, Budde JM, Hatch GF 3rd, Wertheimer-Hatch L, Hatch KF, Davis GB, et al. Tumors of the small intestine. World J Surg. 2000 Apr. 24 (4):421-9. [Medline].
Minardi AJ Jr, Zibari GB, Aultman DF, McMillan RW, McDonald JC. Small-bowel tumors. J Am Coll Surg. 1998 Jun. 186 (6):664-8. [Medline].
BRAASCH JW, DENBO HE. TUMORS OF THE SMALL INTESTINE. Surg Clin North Am. 1964 Jun. 44:791-809. [Medline].
Zollinger RM Jr. Primary neoplasms of the small intestine. Am J Surg. 1986 Jun. 151 (6):654-8. [Medline].
McGarrity TJ, Kulin HE, Zaino RJ. Peutz-Jeghers syndrome. Am J Gastroenterol. 2000 Mar. 95 (3):596-604. [Medline].
Chung CS, Tai CM, Huang TY, Chang CW, Chen KC, Tseng CM, et al. Small bowel tumors: A digestive endoscopy society of Taiwan (DEST) multicenter enteroscopy-based epidemiologic study. J Formos Med Assoc. 2018 Aug. 117 (8):705-710. [Medline]. [Full Text].
Genta RM, Feagins LA. Advanced precancerous lesions in the small bowel mucosa. Best Pract Res Clin Gastroenterol. 2013 Apr. 27 (2):225-33. [Medline].
Sorleto M, Timmer-Stranghöner A, Wuttig H, Engelhard O, Gartung C. Brunner's Gland Adenoma - A Rare Cause of Gastrointestinal Bleeding: Case Report and Systematic Review. Case Rep Gastroenterol. 2017 Jan-Apr. 11 (1):1-8. [Medline]. [Full Text].
Merine D, Jones B, Ghahremani GG, Hamilton SR, Bayless TM. Hyperplasia of Brunner glands: the spectrum of its radiographic manifestations. Gastrointest Radiol. 1991 Spring. 16 (2):104-8. [Medline].
Rüfenacht H, Kasper M, Heitz PU, Streule K, Harder F. "Brunneroma": hamartoma or tumor?. Pathol Res Pract. 1986 Mar. 181 (1):107-11. [Medline].
Bremer EH, Battaile WG, Bulle PH. Villous tumors of the upper gastrointestinal tract. Clinical review and report of a case. Am J Gastroenterol. 1968 Aug. 50 (2):135-43. [Medline].
Ludwig DJ, Traverso LW. Gut stromal tumors and their clinical behavior. Am J Surg. 1997 May. 173 (5):390-4. [Medline].
He LJ, Wang BS, Chen CC. Smooth muscle tumours of the digestive tract: report of 160 cases. Br J Surg. 1988 Feb. 75 (2):184-6. [Medline].
Morgan BK, Compton C, Talbert M, Gallagher WJ, Wood WC. Benign smooth muscle tumors of the gastrointestinal tract. A 24-year experience. Ann Surg. 1990 Jan. 211 (1):63-6. [Medline].
Amin MB, Ma CK, Linden MD, Kubus JJ, Zarbo RJ. Prognostic value of proliferating cell nuclear antigen index in gastric stromal tumors. Correlation with mitotic count and clinical outcome. Am J Clin Pathol. 1993 Oct. 100 (4):428-32. [Medline].
Nincheri Kunz M, Evaristi L, Spadoni R, Cozzani R, Valle O, Bacigalupo B. [Lipoma of the small intestine as a rare cause of intestinal occlusion]. Minerva Chir. 1994 Sep. 49 (9):859-65. [Medline].
Kim YS, Chun HJ, Jeen YT, Um SH, Kim CD, Hyun JH. Small bowel capillary hemangioma. Gastrointest Endosc. 2004 Oct. 60 (4):599. [Medline].
Ramanujam PS, Venkatesh KS, Bettinger L, Hayashi JT, Rothman MC, Fietz MJ. Hemangioma of the small intestine: case report and literature review. Am J Gastroenterol. 1995 Nov. 90 (11):2063-4. [Medline].
Boyle L, Lack EE. Solitary cavernous hemangioma of small intestine. Case report and literature review. Arch Pathol Lab Med. 1993 Sep. 117 (9):939-41. [Medline].
Drolet BA, Pope E, Juern AM, Sato T, Howell B, Puttgen KB, et al. Gastrointestinal bleeding in infantile hemangioma: a complication of segmental, rather than multifocal, infantile hemangiomas. J Pediatr. 2012 Jun. 160 (6):1021-6.e3. [Medline].
Barkay O, Moshkowitz M, Fireman Z, Shemesh E, Goldray O, Revivo M, et al. Initial experience of videocapsule endoscopy for diagnosing small-bowel tumors in patients with GI polyposis syndromes. Gastrointest Endosc. 2005 Sep. 62 (3):448-52. [Medline].
Ziegler KM, Flamm CR, Aronson N. Wireless capsule endoscopy in patients with obscure small-intestinal bleeding. J Am Coll Radiol. 2005 Oct. 2 (10):818-20. [Medline].
Wang H, Luo T, Liu WQ, Huang Y, Wu XT, Wang XJ. Clinical presentations and surgical approach of acute intussusception caused by Peutz-Jeghers syndrome in adults. J Gastrointest Surg. 2011 Dec. 15 (12):2218-25. [Medline].
Cochet B, Carrel J, Desbaillets L, Widgren S. Peutz-Jeghers syndrome associated with gastrointestinal carcinoma. Report of two cases in a family. Gut. 1979 Feb. 20 (2):169-75. [Medline].
Perko Z, Krnić D, Pogorelić Z, Druzijanić N, Simunić M, Bilan K, et al. Peutz-Jeghers syndrome complicated with intussusception: enteroscopic polyps resections through laparotomy. Coll Antropol. 2013 Mar. 37 (1):293-6. [Medline].
Latchford AR, Neale K, Phillips RK, Clark SK. Peutz-Jeghers syndrome: intriguing suggestion of gastrointestinal cancer prevention from surveillance. Dis Colon Rectum. 2011 Dec. 54 (12):1547-51. [Medline].
Metzger PP, Slappy AL, Chua HK. Ileal lipoma. Surg Rounds. 2005. 28(2):84-6.
Minordi LM, Binda C, Scaldaferri F, Holleran G, Larosa L, Belmonte G, et al. Primary neoplasms of the small bowel at CT: a pictorial essay for the clinician. Eur Rev Med Pharmacol Sci. 2018 Feb. 22 (3):598-608. [Medline]. [Full Text].
Iadicola D, De Marco P, Bonventre S, Grutta EM, Barletta G, Licari L, et al. Bowel wall thickening: inquire or not inquire? Our guidelines. G Chir. 2018 Jan-Feb. 39 (1):41-44. [Medline]. [Full Text].
Fujita M, Manabe N, Honda K, Murao T, Osawa M, Kawai R, et al. Usefulness of Ultrasonography for Diagnosis of Small Bowel Tumors: A Comparison Between Ultrasonography and Endoscopic Modalities. Medicine (Baltimore). 2015 Oct. 94 (40):e1464. [Medline].
Newlin ME, Ruiz OR, Taxier M. Using intraoperative enteroscopy for SBD. Cont Surg. 2005. 61(7):340-5.
Karargyris A, Bourbakis N. Detection of small bowel polyps and ulcers in wireless capsule endoscopy videos. IEEE Trans Biomed Eng. 2011 Oct. 58 (10):2777-86. [Medline].
Rana SS, Bhasin DK, Singh K. Colonic lesions in patients undergoing small bowel capsule endoscopy. Int J Colorectal Dis. 2011 Jun. 26 (6):699-702. [Medline].
Kopylov U, Seidman EG. Diagnostic modalities for the evaluation of small bowel disorders. Curr Opin Gastroenterol. 2015 Mar. 31 (2):111-7. [Medline].
Calabrese C, Gionchetti P, Calafiore A, Pagano N, Campieri M, Rizzello F. Sporadic small bowel tumors detected by capsule endoscopy in patients with occult gastrointestinal bleeding. Intern Emerg Med. 2015 Oct. 10 (7):781-5. [Medline].
Rosai J, ed. Rosai and Ackerman's Surgical Pathology. 10th ed. St Louis: Elsevier Mosby; 2011. Vol 1: 673-713.
Toya Y, Endo M, Orikasa S, Sugai T, Matsumoto T. Lipoma of the small intestine treated with endoscopic resection. Clin J Gastroenterol. 2014 Dec. 7 (6):502-5. [Medline].
Lee CM, Kim HH. Minimally invasive surgery for submucosal (subepithelial) tumors of the stomach. World J Gastroenterol. 2014 Sep 28. 20 (36):13035-43. [Medline].
Bedirli A, Salman B, Nasirov M, Dogan I. A Novel Technique for Duodenal Resection and Primary Anastomosis With Robotic Assistance and OrVil. JSLS. 2017 Jan-Mar. 21 (1):[Medline]. [Full Text].
Zou Q, Feng L, Ouyang M. [Option for different surgeries in treating small gastrointestinal stromal tumors]. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2018 Jul 28. 43 (7):767-771. [Medline].
Tang SJ, Zanati S, Dubcenco E, Christodoulou D, Cirocco M, Kandel G, et al. Capsule endoscopy regional transit abnormality: a sign of underlying small bowel pathology. Gastrointest Endosc. 2003 Oct. 58 (4):598-602. [Medline].
ReMine WH, Brown PW Jr, Gomes MM, Harrison EG Jr. Polypoid hamartomas of Brunner's glands. Report of six surgical cases. Arch Surg. 1970 Mar. 100 (3):313-6. [Medline].

Media Gallery

Benign neoplasm of the small intestine. Arteriogram demonstrating small bowel gut stromal tumor, indicated by round tumor blush in lower right corner of the image.
Benign neoplasm of the small intestine. Intraoperative view of an ependymal small bowel stromal tumor. Notice the narrow lesion stalk and high degree of vascularity.
Benign neoplasm of the small intestine. Cross section of a gross ependymal small bowel stromal tumor after removal. Mixed stromal elements and a high degree of cellularity are apparent.

of 3

Sections Benign Neoplasms of the Small Intestine
Overview
Presentation
DDx
Workup
Treatment
Media Gallery
References

Benign Neoplasms of the Small Intestine

Practice Essentials

Pathophysiology

Epidemiology

References

Tables

Contributor Information and Disclosures

What would you like to print?